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Bellisimo

Bellisimo

I really hope there will be more knowledgde soon within doctors so ppl in the future dont have to go thru this or atleast when going thru this, be believed and supported 100% in everyway bc this is just really bad

when im recovered fully imma seriously try infrom every person i know how bad it can be with these drugs

....Go on a number of online forums, however, and you’ll find everything from benign to hellish, and short- to very long-term symptoms. A popular web site for SSRI discontinuation syndrome, called Surviving Antidepressants, offers peer support; the second most visited topic is how to quit, or taper, effectively. Says the administrator in an email, “There are hundreds of thousands of patient postings all over the Web about the difficulties of quitting psychiatric medication and benzos, even under a doctor’s supervision.” The administrator adds that there are dozens of sites like this, set up to help confused patients figure out how to best taper based on other people’s experiences....

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Icandothis

Icandothis

I have to say that although I am really not too confident on how to post correctly, I must say that this is a wonderful site and it is my tool currently in assisting me in my journey tapering off medicine.

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JanCarol

JanCarol

I found Surviving Antidepressants listed as a reference in Katinka Blackford Newman, "The Pill that Steals Lives."

It's an excellent journalistic expose - for every story of her own that she tells, she also tells of others who have suffered worse, and explains the trends in prescribing and how these horrible events cascade into "mental illness."

Healy reviewed it for scientific accuracy. It's a really excellent read - less scholarly than Whitaker, very accessible.

Surviving Antidepressants is listed as the 3rd reference for "Where to get Help."

In this age of chat rooms and social media, an ever-growing number of psychiatric patients use the internet to find their treatment community online. Interactive forums, Youtube.com, and personal blogs are now connecting psychiatric patients in ways that were never before available. One treatment focus for these online communities is complicated withdrawal from psychiatric medications. This article discusses this phenomenon in relation to the well-established forums of benzodiazepine and antidepressant withdrawal.

Online forums, such as www.benzobuddies.org and www.survivingantidepressants.org, provide a platform for patients to support each other as they move through their withdrawal symptoms. These interactive sites feature different strategies for managing a wide range of withdrawal-related symptoms. Other sections provide inspiration for users through sharing stories about a successfully completed withdrawal experience. The traffic moving through these sites is mostly from within the US and is substantial: www.benzobuddies.org receives on average 250,000 hits a month and www.survivingantidepressants.org receives approximately 150,000 hits each month.1,2 It is interesting to note that the patient narratives from these websites are generating early clinical data that researchers are using to learn more about unexpectedly difficult withdrawal symptoms and syndromes.3

A recent article in the New York Times1 and another in the current print edition of Psychiatric Times2 express concern about antidepressant withdrawal syndrome. These articles raise the question: how many people who begin taking an antidepressant will have severe difficulties when they try to taper off?

Surprisingly, this has not been directly studied (per an hour’s negative search on PUB MED, consistent with work by a UCLA social psychologist3). Indirect data suggest the answer is "a lot."4,5 Several clinical trials underway will generate relevant data(eg, 6,7) but they are still not designed specifically to answer this crucial question.

For further insight, we can look at online communities referenced in the PT article. One of the most advanced of these is SurvivingAntidepressants.org. If testimonials might sway your opinion about the potential severity of antidepressant withdrawal difficulties, this site has hundreds.

Testimonials are easy to dismiss. But regardless of your opinion of testimonials as evidence, the posts at SurvivingAntidepressants.org make one thing clear: venlafaxine is among the most difficult of the antidepressants to discontinue. The large steps between dosage strengths require alternative intermediate strategies, but the large number of beads in each capsule make subdivision difficult (one member describes using a grass seed counter to count individual beads). See the Box for a representative post and notice that the author “is capable of differentiating their [sic] own symptoms," eg, insomnia, from withdrawal symptoms.

Other reasons

We have other reasons to avoid venlafaxine. Unlike SRIs, it can raise blood pressure, worsening hypertension, an all-too-common comorbidity with depression. Venlafaxine has also been found more likely to cause manic symptoms, in patients with bipolar disorder, than other antidepressant such as sertraline and bupropion.8 Since ruling out bipolarity is difficult, and since we have many alternatives to venlafaxine with just as much evidence for their efficacy, one can simply choose something else.

Paroxetine causes significantly more weight gain than other SRIs,9 so skip over that one too. Interestingly, paroxetine also appears disproportionately among patients searching for information about how to stop antidepressants.10

Citalopram can cause arrhythmias in patients with long QT syndrome11 so rather than putting patients through the hassle of serial electrocardiograms, skip over that one too.

Alternative antidepressants

This leaves fluoxetine, sertraline—and bupropion. According to a meta-analysis I reviewed in 2016,12 bupropion is nearly as effective for anxiety as are SRIs, counter to general beliefs. And compared with venlafaxine, it has a far lower propensity to induce manic symptoms.8

As published case reports13,14 and SurvivingAntidepressants.org posts show, stopping bupropion can cause withdrawal symptoms too. But on that website, the density of posts about bupropion is far lower than for venlafaxine (143 versus 2130—among posts numbering over 300,000), which certainly matches my clinical experience of difficulties with bupropion discontinuation: far fewer than with all other antidepressants.

Conclusion

Before starting any antidepressant, share with the patient the potential for difficult withdrawal when stopping it. This is tricky—because we don’t know how often people have horrendous experiences that are truly a result of the discontinuation. The folks at SurvivingAntidepressants.org think that we who prescribe antidepressants grossly underestimate the latent risk they carry. At minimum, they would tell us loudly: stop starting venlafaxine.

5

I would say: Stop prescribing Effexor, Pristiq, Paxil, and Cymbalta -- to start.

Dr. Phelps's article also contains a quote from this post by our beloved mammaP: